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PODIATRISTS IN THE NEWS

IL Podiatrist Discusses Onychomycosis

As we age, several factors can contribute to changes in nails. The most common issue is the development of a fungus infection called onychomycosis. "People need to realize that fungus is present in everybody's environment. Aging may also result in decreased circulation to the toenails, and diabetes or other medical conditions put people in an immuno-compromised state which makes them more susceptible to these infections," says podiatrist Dr. Leonard Vekkos.

Dr. Leonard Vekkos

There are prescription topicals such as Penlac and prescription oral medications, such as Lamisil. Both have advantages and disadvantages. "With topical medication, there are no side-effects, but the disadvantage is that it requires nail debridement on an almost daily basis. Additionally, patients are unable to utilize any nail polish. With the oral medications, it requires liver function tests prior to starting treatment. But the advantage is that a patient can continue using nail polish. There is no cure for fungus infections," says Vekkos.

Source: Bonnie Miller Rubin, Chicago Tribune [5/9/12]

PODIATRISTS AND SPORTS MEDICINE

Orthotic or Rigid Shoe Can Prevent Turf Toe: CT Podiatrist

Turf toe usually involves an activity on a firm surface, and is most common in football. The recent popularity of using artificial turf over natural turf is part of the reason for the rise in cases. A force applied to the calf muscle while the knee is flexed is another cause of turf toe.

Dr. Joseph DeFrancesca

“The injury is primarily mechanical in nature and so is the treatment. Putting the foot in a more rigid shoe or an orthotic device will avoid further injury,” said Dr. Joseph DiFrancesca, a Norwich podiatrist who treats many athletes with turf toe. He also thinks careful selection of athletic shoes with a rigid shank will reduce injury rates.

BioElectronics Corporation, the maker of disposable, inexpensive drug-free topical pain and healing devices, has announced the initiation of two independently-run clinical trials on venous stasis ulcers. ActiPatch® and RecoveryRx™ use pulsed electromagnetic field therapy to reduce pain and inflammation and promote the healing of injured tissue.

Dr. Eric Jaakola

The two clinical trials are double-blind, randomized, and placebo-controlled. Both trials are studying the effect of these products on wound healing and the control of wound pain, on venous stasis ulcers, and are currently recruiting patients. One of these important research studies is being conducted by Eric Jaakola, DPM, FACFAS, at the Diabetic Foot and Wound Center, Denver, Colorado, and the second study is being undertaken by Dr. Rasmussen, Associate Professor, Director of Research, Aarhus University Hospital, Aalborg Hospital, Denmark.

Source: Biomedicine [5/9/12]

WOUND CARE RESEARCH - PART 2

Medicinal Honey Improves Wound Healing, Decreases Pain

Floral honey as a secondary dressing can promote healing, minimize slough and necrosis, and reduce the affected area of many types of wounds, according to a prospective observational study published online April 12 in International Wound Journal. Of all the wounds in a study population of European patients who received topical honey as an adjunct to other dressings, 31.4% completely healed and 53.3% improved during an observational period of several weeks, reported Bahram Biglari, MD, from the Department of Paraplegia and Technical Orthopedics, Insurance Association Trauma Centre, Ludwigshafen, Germany, and colleagues. Stagnation occurred in 9.2% of the group's wounds, and 6.1% of the wounds worsened.

To assess pain, investigators asked patients to grade the discomfort they felt on a scale of 0 to 10. The total average pain scores reported between recruitment and the end of the observation period decreased significantly, from 1.71 ± 1.89 to 0.55 ± 1.22 (P < .05; paired Student's t-test). Yet the authors cautioned that "the extent of pain reduction that can be attributed to honey is difficult to evaluate from a non-controlled observational study. A comparative trial with other dressings or remedies would be more conclusive in this regard."

There is little doubt that this is due to a nerve problem. It is most likely a nerve entrapment of one or more multiple nerves in the lower extremity including the common fibular nerve, superficial peroneal nerve, and possibly the tarsal tunnel as well. This patient should be referred to a peripheral nerve specialist for further examination. There are some blood tests that should be run as well to look for underlying systemic reasons for the neuropathy, but referring to a specialist is best.

While we all don't see this often, all of us with a little gray hair have had this patient walk into our offices. I believe your approach needs to be slow and methodical. Get a great history, do a calcium work-up (25 Hydro Vit D, 24 hr urine calcium level, and parathyroid levels). If she smokes, get her to stop or don't do the surgery. Check for equinus. Then, once you have all the information, plan a surgery with removal of all the hardware in the 1st and 2nd metatarsal.

Obtain a cortical/cancellous bone graft from the tibia and re-plate the metatarsals. This time, use BMP and or a bone stimulator and put the patient in an AK cast. I am sure everyone will appreciate the 3 hours of surgery, the hours of follow-up, and phone calls for maybe $1,200 dollars - but that's why we love what we do, helping people with real problems.

Respectfully, I would say that 25 years ago, when I was in school, Dr. Josh Gerbert taught that a 16 degree IM angle would be solidly in the realm of a neck osteotomy. Certainly in 25 years, I have discovered that a textbook is a learning tool, and not every case follows the book. As I recall, the normal metatarsus primus adductus angle is 8-12 degrees, and according to Dr. Gerbert's textbook, a neck osteotomy (Austin) is indicated in an angle of 15 degrees or greater.

I know Dr. Gerbert, and I do not think he made up those numbers. I have not asked him, but I would be willing to bet that there are some very good data to back them up — perhaps these angles have changed, but I don’t think so. I apologize for not including the sesmoid position (which I personally believe is a crucial parameter) in my original post.

A new podiatric sports medicine fellowship program under the direction of Douglas Richie, DPM will begin July 1st 2012. This 13-month program will be based in several clinics and surgery centers Orange County, California and will follow the Fellowship guidelines established by the American Academy of Podiatric Sports Medicine. The Fellow will participate in direct patient care and will receive advanced training in all aspects of sports medicine, podiatric surgery, orthopedic surgery, athletic training, biomechanics and foot orthotic therapy. Salary is $60K and will include benefits and malpractice insurance. A license to practice podiatric medicine in California is required. Applicants must have completed a 24-month podiatric residency program and should send a CV and cover letter describing their current interest and past experience in sports medicine to:drichiejr@aol.comor FAX: 562-596-3157.

Practice Fusion is free and very good. Amazing Charts costs $2,000, plus $500/year to support and will not affect your current billing arrangements. You could also purchase Dragon Medical for about $1,500 to dictate into these programs, if clicking and typing does not meet your work flow. There are other programs through Office Ally, SMS, and MTBC that are free if you use their billing or clearinghouse services. I would stick to the first two suggestions above as they post stronger numbers for attestation. If you can attest to phase I, it will compensate for the oncoming penalties in phase II and III. Amazing Charts and Practice Fusion have nominal costs compared to the incentives.

Amazing Charts offers a three-month free trial that you can download in minutes. There is also a users forum where I believe you can share templates. I do not use any of these programs, but I have reviewed them extensively. I do believe it will help you transition your practice to someone else if you can establish an EMR in your practice. You should save time over handwritten notes or money over dictation. I do not believe Medicare cares about your retirement plans as it relates to EMR requirements.

The root words of chiropody are “chiro” for hand and “pod” for foot. The original chiropodist was actually a “hand and foot practitioner”. (In Ohio, the practice act even allowed hand care by the podiatrist when I grew up there. I believe this has been changed.)

A chiropractor is a practitioner who uses his hands, thus the same root “chiro”. The two doctors were often confused by the public before 1959 when Doctor of Podiatric Medicine was adopted as the universal degree for podiatrists. (For historical reference, at that time, podiatrists had been designated by many doctorates, e.g. DSC, PodD, DPM, etc., depending upon which school awarded the degree.)

I don’t believe we “DPMs” need to have a sub-specialty of “chiropodist” as we perform all our procedures on the lower extremity only. I do believe we need to be “MD”, as this is how we actually function, regardless of whether we do “C&C”, taping, injections, therapy, prescribing, surgery, or any other medical or surgical intervention for treatment of the human body, AND this is what the public and the government understands.

This post unmasks the current sad state of podiatry by revealing a biased posture taken by one of our ranks who passionately feels (as I do as well) that his direction is the best for us to follow. I believe that for the good of our future, we would be better off seeking a middle of the road posture rather than fragmenting our already small forces.

As chiro is "hand" in Greek and has nothing to do with anyone practicing our great profession, I think that using that word is very demeaning coming from a dedicated surgeon like David. Why not posture from my position instead and call us podiatrists, and call him a non-MD orthopedic surgeon?

To offer a more moderate approach, I suggest that DPMs dedicated to practicing wellness, prevention, performance enhancement, quality of life upgrading, and non-operative podiatry be called interventional podiatrists. We would stand in between the pedicurist, the pedorthist, the pharmacy scanner, and the surgeon podiatrist. That way, we would all be podiatrists. I have been practicing my version of the interventional podiatry model very successfully for about two years now as Dr. Gottlieb seems to be practicing his surgical podiatry. Let’s enjoy the future together!

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact:podiatrypracticesale@gmail.com

PRACTICE FOR SALE— BROOKLYN, NY

This practice has been in the same location for 31 years, seeing 80-100 pts/week, working 4.5 days/week. Grossing $350K and netting close to 70%. All surgery referred out. Low rent, option to buy the building in future. Asking $225K, doctor willing to finance. Call 800-983-4194, or email: contactus@podiatrypracticeconsultants.com

ASSOCIATE POSITION - OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

Multi-location group practice seeks motivated DPM with initiative and leadership skills to contribute to our growing group practice. Foot Healers Podiatry Group enjoys a strong reputation within St. Louis and looking for the right individual to complement our team. Must have the confidence to lead you own clinic and the willingness to draw on the expertise that exists within our group. Starting salary ($100k), plus incentive comp plan, malpractice coverage, health insurance, 401k, group bonus/profit sharing. Please send CV to:jmurray@foothealers.comand visit our websitewww.foothealers.com

ASSOCIATE POSITION- FLORIDA

Great opportunity for new practitioner or experienced physician looking to relocate to Florida. Practice currently owned by physicians with a solid patient base after over 12 yrs of practice in this area. Current physicians transitioning to part-time (and eventual retirement from the practice) in order to pursue other business opportunities. Seeking a friendly, dependable, independent ‘go-getter’ who can transition in as seamlessly as possible with staff and patients while maintaining the high-quality foot/ankle care on which our reputation was founded. Start turn-key without need of a bank loan. For more information or to express your interest, please forward your CV to:podiatristsearch@gmail.com

ASSOCIATE POSITION - MIAMI AREA, FLORIDA

Multi-office podiatry group looking for a dynamic and motivated associate to join our practice. Immediate schedule available. Filling in to cover busy schedule and need an energetic associate to expand to your own new office. Competitive salary with bonus incentives. Two or three year surgical residency preferable. Any candidate that applies should be ABPS qualified or certified. Located close to Miami, FL. Send CV toQVAN@aol.com.

ASSOCIATE POSITION-NEW YORK

Full-time position available immediately in Capital District multiple doctor practice. Good salary with percentage. All phases of podiatry. NYS license required. Email resume to:Lchittenden68@gmail.comor call Lori at 518-577-6171

ASSOCIATE POSITION- KANSAS CITY, MISSOURI

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is to his own. Go to:www.YourFutureInPodiatry.comfor full details.

Multi-physician, Multi-office practice looking for motivated new associate leading to partnership. We are a busy practice with state of the art technology: EHR, Digital X-ray, Diagnostic Ultrasound, PADnet, EPAT machine. Applicant should be PMS 36/Board Qualified/Certified. Applicant should be ethical, personable, hard working and interested in providing all aspects of podiatric care to our patients. Competitive Salary and benefits. All interested candidates please send a CV with two letters of reference to:mybestnewjob@gmail.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Very busy, two location group practice seeking a full-time, self motivated and hard working podiatry associate. Competitive salary and benefits are offered. Please email CV to:footcare4all@aol.com

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